Heterogeneous Longitudinal Changes in Corneal Epithelial and Stromal Thicknesses in Patients With Very Asymmetric Ectasia: A Case Series

This study aimed to investigate the longitudinal changes in corneal epithelial and stromal thicknesses in eyes with very asymmetric ectasia that appeared clinically and topographically normal at baseline. Fourteen eyes from 14 patients underwent serial evaluation using corneal topography, corneal tomography, and corneal biomechanical assessment. Based on baseline tomographic and biomechanical parameters, eyes were classified into two groups. Over a mean follow-up of 54 months, eyes with normal baseline parameters showed minimal changes in stromal thickness, whereas a subset of eyes with abnormal baseline indices demonstrated measurable stromal thinning exceeding physiological variability. By contrast, epithelial thickness changes were small and inconsistent across all patients. These findings indicate that eyes with very asymmetric ectasia represent a heterogeneous population and that the longitudinal assessment of corneal layer-specific changes may provide additional insights beyond that derived from cross-sectional evaluation alone.